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Öz

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Anahtar Kelimeler

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Jüvenil İdiopatik Artritte Tedavi Yaklaşımı

Öz

Jüvenil idiopatik artrit (JIA) 16 yaşından önce başlayan, en az 6 hafta süren ve etiyolojisi bilinmeyen artrit olarak tanımlanmaktadır. İnsidansı 16 yaş altı çocuklarda 3,2/100000/yıl ve prevalansı 19,8/100000 olarak saptanmıştır. JIA’lı çocuklarda tedavinin amacı ağrıyı kontrol etmek, eklemin hareket açıklığını ve fonksiyonunu korumak, sistemik komplikasyonları minimize etmek ve normal büyüme ve gelişmeyi desteklemektir. Böylece kabul edilebilir bir hayat kalitesi sağlanabilir. JIA’da hastalık başlangıcından sonraki birkaç yıl içinde radyolojik değişikliklerin geliştiği gösterildiğinden, antiinflamatuar tedavi mümkün olan en kısa zamanda başlanmalıdır. Mevcut ilaçların daha etkin kullanımı kadar yeni geliştirilen ilaçların, özellikle biyolojik tedavi ajanlarının kullanıma girmesi son dekatta JIA tedavisinde oldukça dramatik değişikliklere yol açmıştır. Bu makalede amaç JIA’nın tedavisinde yaygın olarak kullanılan fizik tedavi yaklaşımlarını ve farmakolojik ajanları kliniğimize ait tecrübelerle tekrar gözden geçirmektir

Anahtar Kelimeler

• Jüvenil idiopatik artrit, tedavi

Kaynakça

1. Warren RW, De Guzman MM, Bernal CB, Perez MD. Juvenile idiopathic arthritis (Juvenile rheumatoid arthritis). In:Koopman WJ, Moreland LW (Eds). Arthritis and allied conditions: a textbook of rheumatology. Lippincott Williams&Wilkins. Philadelphia, USA, 2005; pp. 1277-1300.
2. Borchers AT, Selmi C, Cheema G, Keen CL, Shoenfeld Y, Gershwin ME. Juvenile idiopathic arthritis. Autoimmun Rev. 2006;5:279-98.
3. Danner S, Sordet C, Terzic J, Donato L, Velten M, Fischbach M, Sibilia J. Epidemiology of juvenile idiopathic arthritis in Alsace, France. J Rheumatol. 2006;33:1377-81.
4. Ozen S, Karaaslan Y, Ozdemir O, Saatci U, Bakkaloglu A, Koroglu E, Tezcan S. Prevalence of juvenile chronic arthritis and familial Mediterranean fever in Turkey: a field study. J Rheumatol. 1998;25:2445-9.
5. Giannini EH, Brunner HI. Treatment of juvenile rheumatoid arthritis. In:Koopman WJ, Moreland LW (Eds). Arthritis and allied conditions: a textbook of rheumatology. Lippincott Williams&Wilkins. Philadelphia, USA, 2005; pp. 1301-17.
6. Guthrie B, Rouster-Stevens KA, Reynolds SL. Review of medications used in juvenile rheumatoid arthritis. Pediatr Emerg Care. 2007;23:38-46.
7. Jordan A, McDonagh JE. Juvenile idiopathic arthritis: the pediatric perspective. Pediatr Radiol. 2006;36:734-42.
8. Cakmak A, Bolukbası N. Juvenile rheumatoid arthritis: physical therapy and rehabilitation. South Med J. 2005;98:212-6.

9. Passo MH: Emerging therapies in juvenile rheumatoid/idiopathic arthritis. Curr. Probl. Pediatr. Adolesc. Health Care. 2006, 36: 97-103.
10. Ilowite NT. Current treatment of juvenile rheumatoid arthritis. Pediatrics. 2002 ;109:109-15.
11. Kasapçıoğlu Ö, Arısoy N. Jüvenil idiopatik artrit. Türk Pediatri Arşivi 2003;38:8-19.
12. Duffy CM, Gibbon M, Yang H, et al. Nonsteroidal anti-inflammatory drug–induced gastrointestinal toxicity in a practice-based cohort of children with juvenile arthritis. J Rheumatol. 2000;27(suppl 58):73.
13. Alsufyani K, Ortiz-Alvarez O, Cabral D, et al. The role of subcutaneous administration of methotrexate in children with juvenile idiopathic arthritis who have failed oral methotrexate. J Rheumatol. 2004;31:179–182.
14. Kulas DT, Schanberg L: Juvenile idiopathic arthritis. Curr. Opin. Rheumatol. 2001, 13: 392-398.
15. Hashkes PJ, Balistreri WF, Bove KE, Ballard ET, Passo MH. The long-term effect of methotrexate therapy on the liver in patients with juvenile rheumatoid arthritis. Arthritis Rheum. 1997;40:2226–2234.
16. Murray KJ, Lovell DJ: Advanced therapy for juvenile arthritis. Best Prac. Res. Clin. Rheumatol. 2002, 16: 361-378.
17. Ramanan AV, Whitworth P, Baildam EM: Use of methotrexate in juvenile idiopathic arthritis. Arc. Dis. Child. 2003, 88: 197-200.
18. Brooks CD. Sulfasalazine for the management of juvenile rheumatoid arthritis. J Rheumatol. 2001;28:845-53.
19. Van Rossum MA, van Soesbergen RM, Boers M, Zwinderman AH, Fiselier TJ, Franssen MJ, ten Cate R, van Suijlekom-Smit LW, Wulffraat NM, van Luijk WH, Oostveen JC, Kuis W, Dijkmans BA; Dutch Juvenile Idiopathic Arthritis Study group. Long-term outcome of juvenile idiopathic arthritis following a placebo-controlled trial: sustained benefits of early sulfasalazine treatment. Ann Rheum Dis. 2007;66:1518-24.
20. van Rossum MA, Fiselier TJ, Franssen MJ, Zwinderman AH, ten Cate R, van SuijlekomSmit LW, van Luijk WH, van Soesbergen RM, Wulffraat NM, Oostveen JC, Kuis W, Dijkstra PF, van Ede CF, Dijkmans BA. Sulfasalazine in the treatment of juvenile chronic arthritis: a randomized, double-blind, placebo-controlled, multicenter study. Dutch Juvenile Chronic Arthritis Study Group. Arthritis Rheum. 1998;41:808-16.
21. Silverman E, Mouy R, Spiegel L, Jung LK, Saurenmann RK, Lahdenne P, Horneff G, Calvo I, Szer IS, Simpson K, Stewart JA, Strand V; Leflunomide in Juvenile Rheumatoid Arthritis (JRA) Investigator Group. Leflunomide or methotrexate for juvenile rheumatoid arthritis. N Engl J Med. 2005;352:1655-66.
22. Silverman E, Spiegel L, Hawkins D, Petty R, Goldsmith D, Schanberg L, Duffy C, Howard P, Strand V. Long-term open-label preliminary study of the safety and efficacy of leflunomide in patients with polyarticularcourse juvenile rheumatoid arthritis. Arthritis Rheum. 2005;52:554-62.
23. Schimmer BP, Parker KL: Adrenocorticotropic hormone; adrenocortical steroids and their synthetic analogs; Inhibitors of the synthesis and actions of adrenocortical hormones. In: Brunton LL, Lazo JS, Parker KL (Eds). Goodman and Gilman's the pharmacological basis of therapeutics. McGraw-Hill. New York, USA, 2005; pp 1587-1612.
24. Kayaalp SO. Kortikosteroidler, kortikosteroid antagonistleri ve ACTH. Kayaalp SO (Ed). Rasyonel Tedavi Yönünden Tıbbi Farmakoloji. Hacettepe-Taş Kitabevi. Ankara, 2005. s.1079-107.
25. McDonagh JE: Osteoporosis in juvenile idiopathic arthritis. Curr. Opin. Rehumatol. 2001, 13: 399-404
26. Cimaz R: Osteoporosis in childhood rheumatic diseases: prevention and therapy. Best Prac. Res. Clin. Rheumatol. 2002, 16: 397-409.
27. Thornton J, Ashcroft DM, Mughal MZ, Elliott RA, O'Neill TW, Symmons D. Systematic review of effectiveness of bisphosphonates in treatment of low bone mineral density and fragility fractures in juvenile idiopathic arthritis. Arch Dis Child. 2006;91:753-61.
28. Cleary AG, Murphy HD, Davidson JE: Intraarticular corticosteroid injections in juvenile idiopathic arthritis. Arc. Dis. Child. 2003, 88: 192-196.
29. Ilowite NT. Update on biologics in juvenile idiopathic arthritis.Curr Opin Rheumatol. 2008;20:613-8.
30. Lovell DJ, Reiff A, Ilowite NT, Wallace CA, Chon Y, Lin SL, Baumgartner SW, Giannini EH; Pediatric Rheumatology Collaborative Study Group. Safety and efficacy of up to eight years of continuous etanercept therapy in patients with juvenile rheumatoid arthritis. Arthritis Rheum. 2008;58:1496-504.
31. Horneff G, Schmeling H, Biedermann T, Foeldvari I, Ganser G, Girschick HJ, Hospach T, Huppertz HI, Keitzer R, Küster RM, Michels H, Moebius D, Rogalski B, Thon A: The German etanercept registery for treatment of juvenile idiopathic arthritis. Ann. Rheum. Dis. 2004, 63: 1638-1644.
32. Simonini G, Giani T, Stagi S, de Martino M, Falcini F. Bone status over 1 yr of etanercept treatment in juvenile idiopathic arthritis. Rheumatology (Oxford). 2005;44:777-80.
33. Tynjälä P, Lahdenne P, Vähäsalo P, Kautiainen H, Honkanen V. Impact of antiTNF treatment on growth in severe juvenile idiopathic arthritis. Ann Rheum Dis. 2006;65:1044-9.
34. Vojvodich PF, Hansen JB, Andersson U, Sävendahl L, Hagelberg S. Etanercept treatment improves longitudinal growth in prepubertal children with juvenile idiopathic arthritis. J Rheumatol. 2007;34:2481-5.
35. Ruperto N, Lovell DJ, Cuttica R, Wilkinson N, Woo P, Espada G, Wouters C, Silverman ED, Balogh Z, Henrickson M, Apaz MT, Baildam E, Fasth A, Gerloni V, Lahdenne P, Prieur AM, Ravelli A, Saurenmann RK, Gamir ML, Wulffraat N, Marodi L, Petty RE, Joos R, Zulian F, McCurdy D, Myones BL, Nagy K, Reuman P, Szer I, Travers S, Beutler A, Keenan G, Clark J, Visvanathan S, Fasanmade A, Raychaudhuri A, Mendelsohn A, Martini A, Giannini EH. A randomized, placebo-controlled trial of infliximab plus methotrexate for the treatment of polyarticular-course juvenile rheumatoid arthritis. Arthritis Rheum. 2007 ;56:3096-106.
36. Lahdenne P, Vähäsalo P, Honkanen V. Infliximab or etanercept in the treatment of children with refractory juvenile idiopathic arthritis: an open label study. Ann Rheum Dis. 2003;62:245-7.
37. Lovell DJ, Ruperto N, Goodman S, Reiff A, Jung L, Jarosova K, Nemcova D, Mouy R, Sandborg C, Bohnsack J, Elewaut D, Foeldvari I, Gerloni V, Rovensky J, Minden K, Vehe RK, Weiner LW, Horneff G, Huppertz HI, Olson NY, Medich JR, Carcereri-De-Prati R, McIlraith MJ, Giannini EH, Martini A. Adalimumab with or without methotrexate in juvenile rheumatoid arthritis.N Engl J Med. 2008 21;359:810-20.
38. Sundel R . Management of polyarticular onset juvenile rheumatoid arthritis. In:Rose BD (Ed). UpToDate (online database), Waltham, MA, 2008.
39. Kvien TK, Høyeraal HM, Sandstad B. Azathioprine versus placebo in patients with juvenile rheumatoid arthritis: a single center double blind comparative study.J Rheumatol. 1986;13:118-23.
40. Savolainen HA, Kautiainen H, Isomäki H, Aho K, Verronen P. Azathioprine in patients with juvenile chronic arthritis: a longterm followup study. J Rheumatol.1997;24:2444-50.
41. Ostensen M, Høyeraal HM, Kåss E. Tolerance of cyclosporine A in children with refractory juvenile rheumatoid arthritis. J Rheumatol. 1988;15:1536-8.
42. Lehman TJ, Schechter SJ, Sundel RP, Oliveira SK, Huttenlocher A, Onel KB. Thalidomide for severe systemic onset juvenile rheumatoid arthritis: A multicenter study. J Pediatr. 2004;145:856-7.
43. Adams A, Lehman TJA: Update on pathogenesis and treatment of systemic onset juvenile rheumatoid arthritis. Curr. Opin. Rheumatol. 2005, 17: 612-16.
44. Wallace CA. Current management of juvenile idiopathic arthritis. Best Pract Res Clin Rheumatol. 2006;20:279-300.